Rehabilitation of Stroke Patients with Plegic Hands: Randomized Controlled Trial of Expanded Constraint-Induced Movement Therapy

Luckily my doctors didn't seem to know about CIMT, although a friend who was a PT there did know about it.   I would assume that severe upper extremity hemiparesis would disqualify from CIMT because you wouldn't have use of the hand at all. I guess I don't have an understanding of how you would expand CIMT. So because we don't have a public database of stroke protocols this will never get into wide dissemination to all stroke hospitals.
Rehabilitation of Stroke Patients with Plegic Hands: Randomized Controlled Trial of Expanded Constraint-Induced Movement Therapy
Gitendra USWATTEa,b, Edward TAUBa, Mary H. BOWMANa, Adriana DELGADOa, Camille BRYSONa, David M. MORRISb, Staci MCKAYa, Joydip BARMANa, Victor W. MARKa,c,d Departments of aPsychology, bPhysical Therapy, cPhysical Medicine & Rehabilitation, and dNeurology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA

Corresponding Author:  Gitendra Uswatte, PhD, Department of Psychology, UAB, 1720 2nd Avenue S, STE CH415, Birmingham, AL, 35294, USA. Tel.:+1 205 975 5089; Fax: +1 205 975 6140; E-mail: guswatte@uab.edu.

Abstract.  Purpose: To evaluate the efficacy of an expanded form of Constraint-Induced Movement Therapy (eCIMT) that renders CIMT, originally designed for treating mild-to-moderate upper
extremity hemiparesis, suitable for treating severe hemiparesis.  Methods:  Twenty-one adults ≥1 year after stroke with severe upper-extremity hemiparesis (with little or no capacity to make movements with the more-affected hand) were randomly assigned to
eCIMT (n=10), a placebo-control procedure (n=4), or usual care (n=7). The participants who
received usual care were crossed over to eCIMT four months after enrollment. The CIMT
protocol was altered to include fitting of orthotics and assistive devices, selected
neurodevelopmental techniques, and electromyography-triggered functional electrical
stimulation. Treatment was given for 15 consecutive weekdays with 6 hours of therapy
Rehab of Severe Upper-limb Hemiparesis 2

scheduled daily for the immediate eCIMT group and 3.5 hours daily for the cross-over eCIMT
group.  Results:  At post-treatment, the immediate eCIMT group showed significant gains relative to the combination of the control groups on the Grade-4/5 Motor Activity Log (MAL; mean=1.5
points, P<0.001,  f=4.2) and a convergent measure, the Canadian Occupational Performance
Measure (COPM; mean=2.3, P=0.014,  f=1.1;  f values ≥0.4 are considered large, on the COPM
changes ≥2 are considered clinically meaningful). At 1-year follow-up, the MAL gains in the
immediate eCIMT group were only 13% less than at post-treatment. The short and long-term
outcomes of the crossover eCIMT group were similar to those of the immediate eCIMT group. Conclusions:  This small, randomized controlled trial (RCT) suggests that eCIMT produces a large, meaningful, and persistent improvement in everyday use of the more-affected arm in
adults with severe upper-extremity hemiparesis long after stroke. These promising findings
warrant confirmation by a large RCT.